Provider Demographics
NPI:1003251141
Name:FOOT AND ANKLE CLINIC OF THE VIRGINIAS INC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CLINIC OF THE VIRGINIAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOFRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-727-4498
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:WV
Mailing Address - Zip Code:25909-0365
Mailing Address - Country:US
Mailing Address - Phone:800-292-3008
Mailing Address - Fax:866-420-4578
Practice Address - Street 1:2036 LEATHERWOOD LN
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2020
Practice Address - Country:US
Practice Address - Phone:800-292-3008
Practice Address - Fax:866-420-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty